Friday, November 24, 2006

Lock 'em up (revisited)

The Queen's Speech announced the introduction of a Bill to provide a better framework for treating people with mental disorders. The government are intent on reviving the previously axed and heavily criticised Mental Health Bill. It's the return of the thorny questions of diagnosis, compulsion and some rather dubious 'treatments.'

The current Mental Health Act (1983) enables specified professionals to treat people without their consent. The Government now wants to make changes to extend and simplify this process.

The Bill seems to be motivated and promoted by a prejudice that connects mental illness with violence and the need to protect the public. In fact 95% of all killings have no connection to people with mental illnesses. They are mostly the result of drugs and alcohol, but plans have not been proposed to affect the liberty of Friday night boozers. Instead a marginalised and stigmatised section of the population is being targetted.

Currently compulsory treatment can only occur in hospital. The government wants to extend this into the community. So called 'psychiatric ASBOs' will be enforced, the conditions of which may include residency, appointments, medication and 'conduct.' These conditions would not be subject to independent review.

This proposal to restrict the movement and activities of patients in the community has been condemned by mental health workers. Rethink's campaign manager, Jane Harris, said that curfews and banning visits to pubs were completely unworkable. Tony Zigmond, of the Royal College of Psychiatrists, saw the enforcement or monitoring of the conditions being the main problem. He said, 'It's a monitoring exercise that doctors and nurses should not be doing.'

But the main problem is the lack of independent review.

The 1983 Act states that compulsory treatment must help a patient's condition, or prevent it getting worse, this is the treatability clause. The Government wishes to change this to allow treatment that is ‘appropriate’ and ‘available’ i.e. remove treatability as a criterion. The judgement of what is ‘appropriate’ is a subjective one rather than objective, and could include measures to control rather than cure. People with untreatable personality disorders could therefore be compulsorily detained whether they've committed a criminal act or not.

Health services exist to help people with their health, not to control them. Tony Calland, chairman of the British Medical Association's medical ethics committee said, 'Mental health legislation cannot be used to detain people whom the authorities simply want locked away.'

At the moment, two doctors and a social worker are required to make the decision to treat someone without their consent. This is by definition a position of considerable power and responsibility, where the control over another's life is taken. The government's intention is to empower a wider range of healthcare professionals to take these decisions. There is considerable concern that there are insufficient numbers of suitably trained and qualified people for this change to be made.

Treatment without consent can now only be given if a person has a ‘mental disorder’. Again the government wants to expand the definition of mental disorder. This, if used widely, could conceivably include immoral conduct, promiscuity, anti-social or eccentric behaviour and different political or cultural beliefs. Once detained and forcibly treated, that person must wait 6 months until they have a right to have their case reviewed by a Tribunal.